Saturday, March 25, 2006

a question of experience

Let me just say that this post is in no way intended to offend any of the radiologists out there who may stumble upon this blog.
Ok.
So the kid we saw in clinic last night came back this morning. He felt much better. He was playing. He was drinking. My attending decided to get a chest x-ray. The wet read on the x-ray by the radiology resident was that there was no consolidation, no pneumonia.
He still had crackles in his right lung fields, mostly over the middle lobe.
My attending and I scratched our heads for a moment, then looked at the x-ray ourselves. The right heart border on the AP projection was fuzzy, a classic sign of a right middle lobe pneumonia. The lateral projection had a clear consolidation in, you guessed it, the right middle lobe.
We prescribed another 6 days of antibiotics and sent them home.
The moral of this story is to trust your physical exam, as well as your own read on an x-ray. You are your patient's best advocate.

4 comments:

sister smile said...

Wish other doctors felt the same way. Some do; many don't. By the time I finally ditched the primary care doctor I had ten years ago or so, he refused to release my medical records unless I signed a form stating that I wouldn't sue him. I wouldn't sign, and I never got those records. (Nor did I sue him, although I certainly had a case.)

Turboglacier said...

You have an even better case if he refused to release your records. They belong to you (well, technically, the paper they're on belongs to the office, but the information in them belongs to you.)

Wrkinprogress said...

My brother had a huge scare due to a poorly-read chest x-ray -- "something" showing up that wasn't supposed to be there. Luckily, his doc realized there was probably an error in the reading, and sent him to someone he knew for another one. As it turned out, it was the curve of a rib -- which appeared "thicker" than a rib bone would (duh!!!). We were all very relieved that his family doc had such good instincts. Keep up the good work -- we need you to do that for us!

Peace,
WIP

augustknight said...

I have to believe that the radiologist that read that film isn't worth his weight in manure. Not knowing the full set of circumstances I dearly hope that this was an error of neglect and not ability.
I applaud your instinctive pursuit to get the right diagnosis. I feel that radiology is a great tool but without hands on treatment it has the unfortunate characteristic of becoming an abstract.